Michigan Supreme Court

1 Michigan Supreme Court State Court Administrative Office Trial Court Services Division Michigan Hall of Justice Box 30048 Lansing, Michigan 48909 Phone (517) 373-4835 Jennifer Warner Director MEMORANDUM DATE: August 29, 2018 Revised August 31, 2018 FROM: Matthew L. Walker, Forms and Resources Analyst RE: Notice of Revisions to MC 01, JC 04a, JC 04b, JC 66 Notice of Creation of MC 21 Forms MC 01, JC 04a, JC 04b, and JC 66 have been revised and MC 21 has been created. A brief explanation of the changes and a copy of the forms with the changes highlighted are provided below. For questions, comments, or suggestions about these Court forms, contact 517-373-2217 or MC 01, Summons Most recent update: (8/18) version Use of existing stock: Existing stock cannot be used after September 30, 2018. Translated versions of this form will be released at a later date. Click here to see the highlighted form was revised to comply with the Court rule revisions to MCR (D).

2 The title of the form was changed, instructions were added, the venue and signature sections were removed, and the summons section was moved to the bottom of the form. Grammatical corrections were made and citations were updated. August 31, 2018 Page 2 *NEW FORM* MC 21, Case Inventory Addendum (Family Division) Most recent update: (8/18) version Click here to see the highlighted changes. This form was created as required by MCR , , and JC 04a, Petition (Delinquency Proceedings) Most recent update: (8/18) version Use of existing stock: Existing stock cannot be used after September 30, 2018 Click here to see the highlighted changes. This form was revised to comply with the Court rule revisions to MCR (D) and MCR JC 04b, Petition (Child Protective Proceedings) Most recent update: (8/18) version Use of existing stock: Existing stock cannot be used after September 30, 2018 Click here to see the highlighted changes.

3 This form was revised to comply with the Court rule revisions to MCR (D) and MCR JC 66, Application to Set Aside Adjudication(s) Most recent update: (8/18) version Use of existing stock: Existing stock can be used until depleted Click here to see the highlighted changes. This form was revised to accommodate 2018 PA 142. A new item 7 was added for the Michigan Youth ChalleNGe Academy. Subsequent items were renumbered. The words and attach it to your application were added to instruction item 2 for clarification. MC 01 (8/18) SUMMONSMCR (D), MCR (B), MCR , MCR s name(s), address(es), and telephone no(s).vDefendant s name(s), address(es), and telephone no(s).Plaintiff s attorney, bar no., address, and telephone , SCAOO riginal - Court1st copy - Defendant2nd copy - Plaintiff3rd copy - ReturnSTATE OF MICHIGANJUDICIAL DISTRICTJUDICIAL CIRCUIT COUNTY PROBATESUMMONSCASE addressCourt telephone : Check the items below that apply to you and provide any required information.

4 Submit this form to the Court clerk along with your complaint and, if necessary, a case inventory addendum (form MC 21). The summons section will be completed by the Court Relations Case There are no pending or resolved cases within the jurisdiction of the family division of the circuit Court involving the family or family members of the person(s) who are the subject of the complaint. There is one or more pending or resolved cases within the jurisdiction of the family division of the circuit Court involving the family or family members of the person(s) who are the subject of the complaint. Attached is a completed case inventory (form MC 21) listing those cases. It is unknown if there are pending or resolved cases within the jurisdiction of the family division of the circuit Court involving the family or family members of the person(s) who are the subject of the Case This is a business case in which all or part of the action includes a business or commercial dispute under MCL There is no other pending or resolved civil action arising out of the same transaction or occurrence as alleged in the complaint.

5 A civil action between these parties or other parties arising out of the transaction or occurrence alleged in the complaint has been previously filed in this Court , Court , where it was given case number and assigned to Judge . The action remains is no longer pending. NOTICE TO THE DEFENDANT: In the name of the people of the State of Michigan you are notified:1. You are being YOU HAVE 21 DAYS after receiving this summons and a copy of the complaint to file a written answer with the Court and serve a copy on the other party or take other lawful action with the Court (28 days if you were served by mail or you were served outside this state).3. If you do not answer or take other action within the time allowed, judgment may be entered against you for the relief demanded in the If you require special accommodations to use the Court because of a disability or if you require a foreign language interpreter to help you fully participate in Court proceedings, please contact the Court immediately to make dateExpiration date* Court clerk*This summons is invalid unless served on or before its expiration date.

6 This document must be sealed by the seal of the section completed by Court clerk. SUMMONSCase No. TO PROCESS SERVER: You are to serve the summons and complaint not later than 91 days from the date of filing or the date of expiration on the order for second summons. You must make and file your return with the Court clerk. If you are unable to complete service you must return this original and all copies to the Court clerk. OFFICER CERTIFICATEI certify that I am a sheriff, deputy sheriff, bailiff, appointed Court officer, or attorney for a party (MCR [A][2]), and that: (notarization not required)OR AFFIDAVIT OF PROCESS SERVERB eing first duly sworn, I state that I am a legally competent adult who is not a party or an officer of a corporate party,and that: (notarization required) I served personally a copy of the summons and complaint. I served by registered or certified mail (copy of return receipt attached) a copy of the summons and complaint, together with List all documents served with the summons and complaint on the defendant(s):Defendant s nameComplete address(es) of serviceDay, date, time I have personally attempted to serve the summons and complaint, together with any attachments, on the following defendant(s) and have been unable to complete s nameComplete address(es) of serviceDay, date, timeI declare under the penalties of perjury that this proof of service has been examined by me and that its contents are true to the best of my information, knowledge, and belief.

7 Signature Name (type or print) TitleSubscribed and sworn to before me on Date , County, commission expires: Date Signature: Deputy Court clerk/Notary publicNotary public, State of Michigan , County of I acknowledge that I have received service of the summons and complaint, together with Attachments on Day, date, timeSignature on behalf of .PROOF OF SERVICECERTIFICATE / AFFIDAVIT OF SERVICE / NONSERVICEACKNOWLEDGMENT OF SERVICES ervice fee$Miles traveledFee$Incorrect address fee$Miles traveledFeeTOTAL FEE$$Approved, SCAO STATE OF MICHIGANCIRCUIT Court - FAMILY DIVISIONCOUNTYCASE INVENTORY ADDENDUM(FAMILY DIVISION)CASE 21 (8/18) CASE INVENTORY ADDENDUM (FAMILY DIVISION)MCR , MCR , MCR s namevDefendant s nameIn the matter of Instructions: List any known pending or resolved family division cases involving the person(s) named in the complaint or petition or family members of the person(s) named in the complaint or petition.

8 Then, attach the completed form to the complaint or petition. Complete and attach additional sheets if of family division cases include personal protection orders, divorce, custody, paternity, child support, juvenile delinquency, and child protective proceedings. See MCL for a complete : You must serve this form on the other parties with the summons and complaint or information (name, number, and county/state) This Court Other Court or tribunal:Case nameCase / File judgeCase status Pending ResolvedAre support or custody/parenting time orders in effect? Support Custody/Parenting TimeCourt information (name, number, and county/state) This Court Other Court or tribunal:Case nameCase / File judgeCase status Pending ResolvedAre support or custody/parenting time orders in effect? Support Custody/Parenting TimeCourt information (name, number, and county/state) This Court Other Court or tribunal:Case nameCase / File judgeCase status Pending ResolvedAre support or custody/parenting time orders in effect?

9 Support Custody/Parenting TimeCourt information (name, number, and county/state) This Court Other Court or tribunal:Case nameCase / File judgeCase status Pending ResolvedAre support or custody/parenting time orders in effect? Support Custody/Parenting TimeCourt information (name, number, and county/state) This Court Other Court or tribunal:Case nameCase / File judgeCase status Pending ResolvedAre support or custody/parenting time orders in effect? Support Custody/Parenting TimeDate Signature Approved, SCAO1. In the matter of name(s), alias(es), DOBPCS CODE: PETTCS CODE: PETSTATE OF MICHIGANJUDICIAL CIRCUIT - FAMILY DIVISIONCOUNTYPETITION (DELINQUENCY PROCEEDINGS) SupplementalCASE 04a (8/18) PETITION (DELINQUENCY PROCEEDINGS)MCL , MCL , MCL , MCL ,MCR (A)(19), MCR (A), MCR , MCR , MCR A sample for chemical testing for DNA identification profiling is on file with the Michigan State Police from a previous addressORIMI- Court telephone The above named juvenile comes within the provisions of MCL has violated probation as follows: Citations and allegations: operator/chauffeur driver's license commercial driver's license no license vehicle type See attached sheet for further allegations.

10 Member of or eligible for membership in an Indian tribe, as stated a. There are no pending or resolved cases within the jurisdiction of the family division of the circuit Court involving the family or family members of the person(s) who are the subject of the petition. b. There is one or more pending or resolved cases within the jurisdiction of the family division of the circuit Court involving the family or family members of the person(s) who are the subject of the petition. Attached is a completed case inventory (form MC 21) listing those cases. c. It is unknown if there are pending or resolved cases within the jurisdiction of the family division of the circuit Court involving the family or family members of the person(s) who are the subject of the complaint. 4. I designate this case as a case in which the juvenile is to be tried in the same manner as an The juvenile named above is a legal resident of County, and resides in the care and custody of.